post test evaluation of a patient decision aid and ... · shared decision making questionnaire (sdm...

Department of Renal Medicine

Post test evaluation of a patient decision aid and

decision coaching for dialysis choice

Finderup J; Lomborg K; Jensen JD; Stacey D


Dialysis treatment


The intervention: Shared decision-making & dialysis choice (SDM-DC)


Aim & objectives

Aim to evaluate an intervention designed to achieve shared decision-making for dialysis choice Specific objectives 1) to determine if patients experienced shared decision-making 2) to measure decision quality by use of indicators including knowledge,

readiness and preferences.


Setting & Participants

Denmark

Inclusion criteria Exclusion criteria

• eGFR<20 ml/min • Clinical judgement

made by the contact nurse and the contact physician

• Conservative care • A set date for a

transplantation with a living donor

• Not able to participate due to cognitive impairment

[1st October 2016 – 31st May 2018]


Data collection & analysis

• Mixed method (concurrent convergent design) • Questionnaires

– Shared Decision Making questionnaire (SDM Q9) – Decision Quality Measurement (DQM) – Stata 15.0

• Semi-structured individual interviews – Interview guide (Kvale & Brinkmann) – Systematic text condensation (Malterud) – NVIVO 12.0

Strategy

Sequential

Concurrent

Variation

Explanatory

Exploratory

Transformative

Convergent

Nested

Transformative

Description

QUANqual

QUALquan

QUANqual

QUALquan

QUAN/QUAL Results compared

Qual/QUAN OR Quan/QUAL

QUAN+QUAL

Qual/QUAN

Mixed method [Cresswell & Plano Clark, 2017; Hayes B, Bonner A & Douglas, 2013]


Flow diagram of participants


Patient characteristics The intervention sample (n=349)

n (%)

Hospitals

I II III IV

180 (52) 53 (15) 60 (17) 56 (16)

Sex Female Male

123 (35) 226 (65)

Age (years)

age < 40 40 ≤ age < 50 50 ≤ age < 60 60 ≤ age < 70 70 ≤ age < 80

age ≥ 80

17 (5) 21 (6) 45 (13) 94 (27) 112 (32) 59 (17)

eGFR (ml/min) eGFR < 10

10 ≤ eGFR < 20 eGFR ≥ 20

82 (23) 244 (70) 23 (7)

Attended Kidney School

Yes No

103 (30) 246 (70)

Number of meetings

1 2 3 4

90 (26) 215 (62) 40 (11) 4 (1)

Chosen option

Home Peritoneal dialysis

Home haemodialysis Dialysis at hospital

No decision

228 (65) 26 (8) 87 (25) 8 (2)

Before the intervention

After the intervention


Patient characteristics

The study

Sample (n=148) n (%)

The non-study Sample (n=201)

n (%)

Chi test or Fisher's exact test

Hospitals

I II III IV

61 (41) 18 (12) 49 (33) 20 (14)

119 (59) 35 (17) 11 (6) 36 (18)

<0.01

Sex

Female Male

53 (36) 95 (64)

70 (35) 131 (65)

0.849

Age years

age < 40

40 ≤ age < 50 50 ≤ age < 60 60 ≤ age < 70 70 ≤ age < 80

age ≥ 80

4 (3) 10 (7) 18 (12) 36 (24) 61 (41) 19 (13)

13 (7) 11 (6) 27 (13) 46 (23) 63 (31) 41 (20)

0.153

eGFR ml/min

eGFR < 10

10 < eGFR < 20 eGFR > 20

30 (20) 110 (74)

8 (6)

52 (26) 134 (67) 15 (7)

0.301

Attended Kidney school

Yes No

62 (42) 86 (58)

41 (20) 160 (80)

<0.01

Number of meetings

1 2 3 4

17 (12) 102 (69) 27 (18) 2 (1)

73 (36) 113 (56) 13 (7) 2 (1)

<0.01

Chosen option

Home Peritoneal dialysis

Home haemodialysis Dialysis at hospital

No decision

105 (71) 14 (10) 27 (18) 2 (1)

123 (61) 12 (6) 60 (30) 6 (3)

0.039


Shared Decision Making questionnaire (SDM Q9)

Statements

Total (n=148)

Mean (SD)

Home-based treatment (n=121)

Mean (SD)

Hospital-based treatment

(n=24) Mean (SD)

1. The dialysis coordinator made it clear that a decision needs to be made 4.16 (1.10) 4.13 (1.08) 4.21(1.22)

2. The dialysis coordinator wanted to know exactly how I want to be involved in making the decision

4.03 (1.09) 4.05 (1.06) 3.83 (1.24)

3. The dialysis coordinator told me that there are different dialysis modalities for treating my kidney failure

4.63 (0.66) 4.65 (0.67) 4.46 (0.66)

4. The dialysis coordinator precisely explained the advantages and disadvantages of the treatment

4.50 (0.72) 4.52 (0.71) 4.42 (0.83)

5. The dialysis coordinator helped me understand all the information 4.47 (0.70) 4.47 (0.71) 4.50 (0.66)

6. The dialysis coordinator asked me which dialysis treatment option I prefer 4.60 (0.70) 4.63 (0.68) 4.42 (0.78)

7. The dialysis coordinator and I thoroughly weighed the different dialysis treatment options

4.44 (0.76) 4.44 (0.76) 4.42 (0.78)

8. The dialysis coordinator and I selected a dialysis treatment option together 3.64 (1.48) 3.74 (1.36) 3.17 (1.86)

9. The dialysis coordinator and I reached an agreement on how to proceed 4.28 (1.02) 4.32 (0.91) 4.13 (1.45)

Total (standardized out of 100) 86.10 (12.19) 86.57 (11.71) 83.43 (14.59)


Shared Decision Making questionnaire (SDM Q9)

I: You disagreed, that the dialysis coordinator and you selected a dialysis treatment option together. P16: No, that's my own decision I: You agreed, that the dialysis coordinator and you selected a dialysis treatment option together. P7: Yes and no, I both agree and disagree. It was my own choice, but the dialysis coordinator also confirmed my choice and contributed to the decision.


Decision Quality Measurement (DQM)

Statements

Total (n=148)

Home-based treatment (n=121)

Hospital-based treatment

(n=24)

Know

ledge

item

s

1. Peritoneal dialysis is a treatment that takes 30 minutes once a day 82% 86% 75%

2. You need a specific room for dialysis 78% 81% 63%

3. I can eat and drink whatever I like when I am on any type of dialysis 68% 69% 58%

4. I can go on holiday if I am on dialysis 96% 97% 96%

5. Dialysis is usually only needed for a few months 95% 96% 92%

6. Home haemodialysis is suitable for people who want to take responsibility for their own treatment

74% 75% 67%

Total Knowledge Score 82% 84% 75%

Readin

ess

item

s

7. I know the options available to me 97% 98% 96%

8. I understand the options available to me 99% 99% 100%

9. I am aware of the advantages of each option 93% 95% 88%

10. I am aware of the disadvantages of each option 88% 88% 83%

11. I know how I feel about each option 73% 75% 67%

12. I can imagine what it would be like to live with each option 68% 69% 71%

Total Readiness Score 86% 87% 84%


Decision Quality Measurement (DQM)

P3: I am not able to remember that. I have for sure heard that peritoneal dialysis is at night. But I have forgotten all about it. I have totally forgotten it. I: You have trouble to remember and you bring your husband to help you to remember? P3: Yes I have trouble to remember.


Concordance score

“An association between a specific choice and a specific preference” [Sepucha et al 2011] 89 % of the patients had made a concordant decision

Decision

Home-based

treatment

Preference

Treatment at home

Concordant decision

Decision

Hospital-based

treatment

Preference

≠

Treatment at home

Concordant decision


Decision quality score

“An association between a high knowledge score and a concordance score” [Stacey et al 2016]

83 % of the patients had made a quality decision

A knowledge

score >66%

A concordant

decision

Decision quality

Strengths

• Implemented at four different hospitals in Denmark

• Mixed methods design

• Using patient and public involvement in the research process


Weaknesses

• No comparator

• Low response rate for the questionnaires

• DQM has a lack of validation

• SDM Q9 measured the SDM-process only partly


Conclusion

• > 80% of participants experienced shared decision-making and reached a ‘high-quality’ decision

• No differences between participants who chose home- and hospital-based treatment

• Qualitative findings supported the quantitative results

post test evaluation of a patient decision aid and ... · shared decision making questionnaire (sdm...

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